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“Medicaring” for the Elderly

By Ariel Doyle, Halee Keller, Karina Estrada, and Tariq Al mahrouqi

Introduction

When asked how they would rather spend their last days of their life, 65% of adults say that they would rather spend it in hospice care or at home (Friedman). Unfortunately, not everyone is able to have that wish granted. Our group study was over the various facilities in Omaha for elderly care. There were ten facilities chosen, and all of them were located in different parts of the city. Each member of the group analyzed the website of each facility, and recorded information on a standard chart. From this data, there was a connection made between quality of life and the limitations various people encounter when it comes to end of life care. Each website was looked to see if that Nursing Home (NH) accepts Medicare and Medicaid, and looked for prices as well.

In this project, the five main things that will be discussed are Choices of Care, Social Activities, Health and Hygiene, Religion, and Medicare and Medicaid. Each of these five topics are important for the elderly to look at when choosing a NH that they wish to reside in. Each section will look at data found from each of the 10 Omaha NH including the amount of choices, costs, and the influences of Medicare and Medicaid.

Theme 1: Choices of Care

Choices of care relates to the overall theme because of the different merits and costs of private versus shared rooms. There are a variety of choices that lifestyle communities offer, but the two main differences are that some offer private luxurious suites and apartments while others focus on basic companion rooms. With the list of NH’s, the two main things noticed were in relations to choice of care. Those two are the types of services provided between suites/apartments and companion rooms and the different payment options.

Most of the NH websites included different housing options. About half of them showed in detail the variety of apartments and suites available to residents, including a long list of amenities that come with it. On the other hand, the companion rooms (shared rooms) listed different services available but they didn’t come included with the plan. Individuals had the freedom to choose from the different types of care offered, while the suites and apartments already included this with the plan. So this comes to question, why do the luxurious suites and apartments include the services while the companion rooms don’t?

According to the journal article titled, “ Care Needs of Higher- Functioning Nursing Home Residents” illustrated that “Residents pay $7,000 to $11,000 a month for private rooms and such amenities.” (McNabney) This shows how extremely expensive it is to have a private suite plus services included. These lifestyle communities already offer an expensive place that is affordable to some people, so adding such amenities really makes no difference to them. On the other hand, there are companion rooms which can be described as a moderate shared room between two residents. These rooms usually include two single beds, a shared closet, and television. Now the major difference between suites and companion rooms, is that one has the opportunity to choose what kind of services they would like to receive with the shared rooms. For that reason, the prices for the shared rooms tend to be less than the luxurious suites or apartments.

The last point that caught my attention was the different payment options offered between the suites and shared rooms. It was realized that the websites of the expensive suites either didn’t show if they accepted government assistance as a payment option, such as Medicaid or Medicare or stated that they didn’t accept Medicare. On the other hand, most of the facilities that included companion rooms accepted Medicaid or Medicare as a payment option. The different payment options also have to do with the merits residents get. According to Charles Phelps, the extravagant rooms have “the most value added to the residents.” This becomes an issue because it clearly shows how many limitations there are when it comes to quality of care.

Theme 2: Social Activities

Social activities theme and overall themes have a great relationship, the overall themes talks about NH services, and social activities theme is one of the essential services that being offered the majority of NH’s. Elderly’s life must have several activities to make them avoiding feel depressed of their life. Social activities in NH’s always have a significant impact on elderly’s health, so that’s the primary reason that make NH’s care always about the social activities, however, not all NH’s have the same social activities and that based on NH’s services. Some of NH’s are expensive, but they offer a lot of essential social activities. On the other hand, some of NH’s are cheap, but they do not offer medicare and social activities, which that mean it depends on how much one pays for NH’s.

In fact, social activities and sociology have a great relationship that can be realized easily especially in NH’s community. According to the Buzzle web page, “Any physical activity will increase the elderly people body movements which they otherwise avoid out of fear of injury. When they are involved with some tasks, it helps them to get rid of depression, concentration problems and memory loss. It adds up to their confidence and gives them a sense of independence. There are creative activities and cultural activities specifically designed for the elderly which should be included in their daily life. Such a step also contributes to the society as some people can come to know about their special skills. “As a result, that clearly demonstrates how social activities are important to be offered in nursing homes. The social activates that being offered in NHs always impact elderly positively by making them more connected and knowing each other, also social activities help elderly to avoid the gap that might be between poor and rich elderly.” Moreover, social activities are really essential factor that can make the person healthier mentally and physically.

Also, numerous studies have been done on socialization and maturing and the most up to date study uncovers that a man can’t gain social abilities without a deep rooted presentation to social circumstances. In fact, people can’t expect elderly individuals, who have been a “shut-in” every one of their lives, to all of a sudden have a longing to invest energy in a senior resident focus. According to chapter (5) of sociology book, without stopping for even a minute, being friendly. It might require an investment of move before she/he feels prepared for more social situations. In addition, an elderly individual has effectively settled the level of cooperation with others that they seek. It is a lifetime of figuring out how to associate with others in work, play, and different exercises. Also, some times our friend groups typically gets to be littler. The explanation behind this is companions can pass away or get to be crippled to a state of not having the capacity to drive. The life partner that is deserted comes to rely on their kids or other relatives for exercises and incitement. However, there are different ways can help elderly a life-long being away of the isolation problem. For example, Participate in senior groups, to illustrate more, Contact the nearby wellness focus, town corridor, or data place for thoughts of gatherings that meet in group. Senior focuses have been built up to facilitate the move of maturing. They arrange exercises, for example, exercise, suppers, amusements, and outings.

Theme 3: Hygiene and Health

According to Keirns, there are two different types of aging. The first is called primary aging, which is biological changes, such as cellular and molecular changes. The second is called secondary aging. This aging is usually due to poor dieting and lack of exercising, which makes it important that facilities are able to accommodate the elderly with options for food and exercising needs. Which will be looked at in this section.

Because dieting is an important part of health, facilities should have multiple ways for their residents to eat. One of the ways that the 10 NH’s chosen provide ease for their residents is to offer dining services. Restaurant style dining is one option that was commonly found on the websites. However, restaurant style dining has many subcategories as well. Many places offer a buffet. This allows residents to not only pick and choose what they would like to eat, but it also allows them to choose how much they want to each of each item as well. Residents are able to make their own dietary restrictions and are able to take care of their bodies using this method. Another style offered is fine dining. In this style, NH residents usually sit down and employees will come around and take orders. Residents can feel like they are eating at a nice restaurant using this style. Because not all residents are able to eat at the same time, two of the NH’s that were viewed offered open and extended dining hours for convenience.

If restaurant style eating is not what the resident wants to do that day, many places also have other options for them. For those who do not have the strength to go out that day or are just not feeling well, a few places also offer room service. For those who have restaurant style dining in their NH

facilities, it is important because it allows those who are not able to go out or cook for themselves that day to make sure they get their meals. It also helps them not to stress out and worry about having to cook when they are not able to. For those who are in assisted living and are totally unable to leave their rooms, it is a way of life for them that they depend on. Another service that many places offer are snacks and on the go meals. Some places offer a certain area that is always filled with snacks and food that residents can grab at any point in the day. Other places will distribute snacks out through their employees to manage how many snacks that residents are getting.

A few places also offered kitchens in their own apartments. This could include full sized kitchens, which typically include a full sized fridge, oven, dishwasher, and microwave. The other style that is offered is a kitchenette style. Kitchenettes are smaller than a normal kitchen and typically include a full fridge, sometimes mini fridges are used instead, and a microwave. Kitchens are usually offered in the independent living homes while kitchenettes are usually the choice of style for assisted living homes. But that does not guarantee that residents will get a kitchen or kitchenette. The places that accept Medicare or Medicaid are the only ones that did not include kitchens and kitchenettes within the apartments offered in the NH’s. Every single place that did not list or did not accept Medicare or Medicaid did include a kitchen within their own apartments.

Out of the 10 websites used, each listed different ways to help their residents keep up on their hygiene and health. Three of these things are salons, laundry and housekeeping, and bathing. The most common service provided which has no correlation with acceptance or deniance of Medicare and Medicaid are beauty and barber salons. Although it is not listed on the websites, it is safe to assume that NH’s have salons in their buildings to allow ease for their residents as well as have another social aspect in their building. Besides convince and other social area, salons are important for health. Having a salon encourages residents to take care of their hair, which includes washing it. Washing hair keeps the hair healthy, which in turn keeps the residents healthy as well. On top of that, making sure residents are bathed and clean helps to keep everyone living and working in the facility healthier as well. It helps to prevent diseases from spreading as well as keeping each individual person healthy. Places that do accept Medicare and Medicaid are more likely going to have nursing assistance. This can mean help with bathing, whirlpool baths, and giving out medicines.

Laundry, clean clothes, and a clean room are also another thing to keep on to maintain health and hygiene. Places that do not accept Medicare and Medicaid offer washers and driers in the unit, or at least a hook up with a community laundry center in the facility. On the flip side, places that do accept Medicare and Medicaid offer laundry services. Between the NH’s that accept Medicare and Medicaid, services offered are personal laundry done up to twice a week as well as housekeeping once or twice a week. This part actually offers more services for those going to a place that does accept Medicare and Medicaid plans. However, this is due to the fact that they are in assisted living and are not able to do it themselves.

It is important for the elderly to exercise as it reduces secondary aging (Keirns). One of the ways that this can be done is by walking around hallways, or outside around the facility. One home even has a walking area around a lake on their property for their residents to use. This set up is not ideal for everyone, however. Because of this, a few NH’s have exercise facilities within them. The two NH’s that include them within the building do not list if they accept Medicare or Medicaid, once again showing that if the NH does not list if they accept it, they are more likely to provide more options.

In one study done by Sugimoto, two groups of females, pre-frail and healthy, were part of a yearlong program that tested one-legged standing, 5-m walking, grip testing, and Timed Up and Go (TUG). At the end of the year, the study showed that grip testing was around the same. The TUG testing was much higher than before in both groups, as well as 5-m walking. The one-legged balance also showed an increase with both groups, the healthy group doing better than the pre-frail (Sugimoto.) All of this testing shows that exercise does in fact help elderly walk and increase strength with exercise. As stated earlier, retirement homes that accept Medicaid do not have fitness centers or offer less classes to keep their residents in shape.

Theme 4: Religious Care

It is a common belief that people become more religious as they age, especially towards the end of life. Many people realize that the end of life is near, and their moral beliefs become more relevant in everyday life. However, the Florida Retirement Study shows the opposite of this popular belief. According to the data, which was collected through an interview process, one’s religiosity declines as they age (1514, 1522). The interviews included 1.000 people over the age of 72, which showed that over 96% of participants considered themselves religious and attended church on a weekly basis (1514, 1518). The data showed a surprising decline in service attendance, in correlation with an increase in age (1523). While this is surprising and contrary to popular belief about the elderly and religion, it is caused by an obvious factor. The cause of this decline was not clearly definable, but some possible causes are the physical limitations that come with aging (1525). Several additional statistical relationships were found, such as an equal amount of men and women who consider themselves religious (1523). Fortunately, the decline in service attendance is made almost impossible by Omaha facilities.

Out of the ten facilities studied, nine clearly advertised an on-site chapel, with weekly, if not daily, services. If a certain denomination could not find services on site, the facility offered transportation to an appropriate church every Sunday. Furthermore, chapels and services were all open to family and friends of residents. This makes it very easy for residents and families to attend church together on a regular basis. An increase in practices such as religious service attendance can improve emotional, and even physical health. Clearly, facilities are well aware of the importance of religion to the elderly.

Theme 5: Medicaid and Medicare Acceptance

According to the text, Introduction to Sociology 2e, Medicare is government funded healthcare that is available to people over sixty-five, or those with disability (440). In addition, Medicaid is a government funded healthcare provider that is available to those with low income (440). While it may seem like there are many options available for healthcare coverage, a considerable amount of Americans are not covered by health insurance. Even those who do have government funded coverage do not qualify for certain living facilities, because they do not accept Medicare. This shows just how difficult it can be for the elderly to find good end of life care. Out of the ten living facilities examined, only three of them explicitly stated their acceptance of Medicare coverage. An additional two accepted public funding, but did not advertise it well on the website. The remaining five either stated a no Medicare policy, or failed to advertise on the subject. As already stated, many of these facilities are nicely furnished, with weekly housekeeping and good quality dining options. While this creates a comfortable environment for end of life care, it also costs a considerable amount of money. The current aging population is part of the “baby boomer” generation, which means there is an increasing need for end of life care, and not enough coverage to provide it. The Sociology textbook touches on this as well: “Approximately two-thirds of early boomer households have not accumulated enough savings to maintain their lifestyle” (287). There is a great need for better coverage and health care availability for the elderly in Omaha.

On that note, Medicare also plays a large role in providing hospice care for the elderly. While many of the NH’s provide hospice, Medicare has certain conditions and limitations. In order to qualify for Medicare coverage of hospice, according to the Widener Law Review, one must be eligible for Medicare, be determined terminally ill, and sign away all coverage of treatment for their terminal illness (446). Due to the fact that patients can be referred to hospice an unlimited amount of times, Medicare also places caps on hospice centers, in order to reduce spending (448). They require hospice centers to pay back any amount that exceeds their yearly allowance (448). Therefore, in addition to having nowhere to live comfortably at the end of life, it is increasingly difficult for the elderly to receive hospice care. Hospice can provide a vast improvement to one’s quality of life. According to the Widener Law Review, hospice provides psychological benefits, which lead to physical benefits like lower blood pressure, stronger immune systems, and higher effectiveness of Medications (449). Clearly, hospice does a great service to both the patient and their family, and Medicare regulations put a strain on that service.

Conclusion

In conclusion, a big influence on what NH’s provided was based on if they accepted Medicaid or Medicare as well as the cost. With choices of care, the more expensive and out of pocket the NH was, the more choices and freedom the residents had. Social activities also became more accessible and more opportunities were provided if Medicare and Medicaid. Health and Hygiene offered more food choices and styles as well as less one on one care if Medicare and Medicaid were accepted. Religion was offered at every NH with the exception of one. In the Medicare and Medicaid section, it was discussed how more money is more important in some of these homes as well as the accessibility to enter a NH with those two options.

 

 

 

Works Cited

Bidisha Mukherjee. “Social Activities for the Elderly.” Buzzle. Buzzle.com, 7 Apr. 2016. Web. 8 Apr.            2016.

Cerminara, Kathy L. “Hospice And Health Care Reform: Improving Care At The End Of Life.” Widener

Law Review 17.2 (2011): 443-473. Academic Search Complete. Web. 28 Apr. 2016.

Friedman, Susan M., et al. “Characteristics Predicting Nursing Home Admission In The Program            Of All-Inclusive Care For Elderly People.” Gerontologist 45.2 (2005): 157-166.            Academic Search Complete. Web. 19 Apr. 2016.

Keirns, Nathan J., Eric Strayer, Heather Griffiths, Susan Cody-Rydzewski, Gail Scaramuzzo,            Tommy Sadler, and Sally Vyain. Introduction to Sociology. Print.

McNabney, Matthew K., et al. “Care Needs Of Higher-Functioning Nursing Home Residents.”            Journal Of The American Medical Directors Association 8.6 (2007): 409-412. Academic            Search Complete. Web. 7 Apr. 2016.

Pesis-Katz, Irena, et al. “Making Difficult Decisions: The Role Of Quality Of Care In Choosing A              Nursing Home.” American Journal Of Public Health 103.5 (2013): e31-e37. Academic Search            Complete. Web. 28 Apr. 2016.

Sugimoto, Hiroe, et al. “Changes In The Physical Functions Of Pre-Frail Elderly Women After            Participation In A 1-Year Preventative Exercise Program.” Geriatrics & Gerontology            International 14.4 (2014): 975-982. Academic Search Complete. Web. 7 Apr. 2016.

Wang, Kuan-Yuan, Kyle Kercher, Jui-Yen Huang, and Karl Kosloski. “Aging and Religious            Participation in Late Life.” Journal of Religion and Health J Relig Health53.5 (2013): 1514-528.            Web.

 

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